Symptoms
VARIETY - TMJ disorders can produce such a wide variety of symptoms that the condition used to be called "the great imposter". The most common include facial pain, difficulty chewing and swallowing, limited mouth opening, unexplained (phantom) tooth pain, headaches (including common migraines), blocked eustachian tubes (stuffy ears), dizziness (vertigo), ringing or whooshing sounds in the ears (tinnitus), and chronic neck and postural tension. All these symptoms rarely occur together in one patient, and most patients suffer from only a few of them. For example, some only experience headaches, some only experience facial pain, and some only experience ear problems. A few people also suffer from unusual visual disorders or idiopathic neurosensory disorders, like twitching or numbness, that respond to TMJ disorder treatment along with the other symptoms, although we don't understand the mechanisms involved. Even neurologic conditions of unknown etiology, like Tourette's syndrome, are sometimes reportedly eliminated by TMJ treatment; but not by any particular type of TMJ treatment.
ACUTE TMJ PROBLEMS - are characterized by TMJ inflammation, which produces swelling that stretches the joint capsule and thereby pushes the affected condyle down and away from the skull like expanding a bag of water under a table leg. The downward shifting of the affected condyle separates the back teeth on that side. Biting forcefully to try and contact the separated back teeth on that side produces immediate pain, because it drives the condyle into the swollen area. The pain can be temporarily eliminated by biting on a small object like a tongue blade placed between the second molars on the side of the inflammation, because applying a bite force at that location behind the center of the jaw closing muscles pries the condyle down and away from the swollen area.
JAW MUSCLE TENSION - always accompanies TMJ inflammation, because muscles automatically tighten up to protect injured or unstable joints. They increase their background tension or tonus. When a TMJ is inflamed, the jaw muscles stay hypervigilant and can never fully relax. The bite functions like a joint between the upper and lower jawbones, so an unstable bite can also tighten the jaw muscles. The increased jaw muscle tonus resulting from these joint conditions lowers resting circulation through the muscle capillary beds. When tonus goes up from one percent to two or three percent, it can prevent resting circulation from being able to adequately flush out the waste products of metabolism. Little pockets of waste products that form present clinically as trigger points - pea shaped nodes that are exquisitely sensitive to manual pressure. When compressed, they can cause pain in the teeth or at locations surprisingly far away in typical "pain referral" patterns, which can persist long after their original cause has been eliminated. In this manner, the jaw muscle tension causes the pain, but the TMJ inflammation or the unstable bite is the cause of the jaw muscle tension.
After the jaw muscle tension has become chronic, the jaw muscles can shorten anatomically in a process known as contracture. They no longer hang open so far. The shortened postural position can become "cemented in" with fascia, requiring forceful stretching to restore normal resting lengths to the involved muscles.
POSTURAL STRAINS - are always involved, because the mandible is part of the neck, and the jaw muscles are part of the head posture mechanism. Many health practitioners point out that postural strains can misalign the jaw, but few understand how a misaligned jaw can cause postural strains. Backward jaw posture causes forward head posture, and laterally shifted jaw posture causes the head to tip to the side of the shifted mandible. That subject is covered extensively in BITES AND BODY POSTURE under the FOR DOCTORS tab.
TRIGEMINAL NEURALGIA - is a condition characterized by unpredictable sudden and extremely acute attacks of pain that have been described as feeling like you've been run over by a train. It is often misdiagnosed as the cause of TMJ disorder pain. The pain may be similar to an acute TMJ disorder, but the epidemiology is not. Trigeminal neuralgia is rarely found in people under middle age, while acute TMJ disorders are rarely found in or beyond middle age. The cause of trigeminal neuralgia is not an inflamed TMJ or tight jaw muscles. The cause was thought for some time to be pressure from the brain on the trigeminal nerve, leading to decompression brain surgery, but more recent MRI evidence indicates that glymphatic dysfunction is involved. The glymphatic system is described in CRANIAL AND CRANIOSACRAL under TREATMENTS.
HEADACHES - of all kinds are very common TMJ symptoms. Clinically, TMJ disorders can cause sinus headaches, temporal headaches, occipital headaches, or common migraines. In fact, your description of your headache does not tell us anything about its cause. The jaw muscles attach all over the sides of the head, and they can apply significant pressure to the cranium. They can pump the cranial bones, which enhances glymphatic circulation. For that reason, chewing stimulates cranial blood flow and frontal cortex activity, and studies have shown a connection between jaw muscle function and cognitive decline. Depriving older animals of chewing by softening their food or removing their molars leads to loss of spatial memory, reduced learning capacity, neuro-endocrinal changes, and hippocampal degeneration. In humans, loss of teeth is associated with faster cognitive decline, and it’s been shown that chewing stimulates cranial circulation and frontal cortex activity. Jaw muscle firing compresses the cranium vertically, which could help pump out waste products through perivenous channels.
Sustained pressure from tight jaw muscles probably produces headaches by disrupting local glymphatic circulation, leading to irregular CSF pressures in localized areas of the cranium. Recent MRI studies suggest that the closure of the perivascular spaces, which results in impaired clearance of waste products from neural metabolism into venous circulation along perivenous pathways, usually precedes migraine and could play a critical role in migraine pathogenesis. The impaired glymphatic circulation could certainly produce localized increases in intracranial pressure, and there is no evidence that the pressure frequently described in headaches is not real or that the pressure sensors in our cranium are not accurate like all our other pressure sensors. Any cervical constriction, such as a forward or twisted head posture, can impede glymphatic drainage into the venous and lymphatic channels at the base of the neck. The glymphatic circulation process is described in CRANIAL AND CRANIOSACRAL under the tab TREATMENTS.
EAR SYMPTOMS - include dizziness (vertigo), tinnitus (ear ringing), stuffiness (blocked eustachian tubes), and frequent difficulty hearing what people say (subjective hearing loss). There are two common causes of these ear symptoms in TMJ disorders, and effective treatment depends on determining which one needs to be addressed in each case.
One cause of the ear symptoms is tight muscles. Muscles maintain a light background tension called tonus, the level of which is determined by the electrical signals in the motor nerve to the muscles. The ear, the bite muscles, the TMJ and the eustachian tube with the tensor veli palatini muscles are all innervated by mandibular branches of the trigeminal nerve and have functional neuromuscular interaction, therefore masticatory muscle hyperactivity may lead to increased tonicity of the tensor veli palatini and tensor tympani muscles.
The tensor tympani muscle tightens the ear drum; and when its resting tonus is disturbed, it can cause tinnitus by pulling on the drum when it should not be. It can also cause subjective hearing loss, because your ear is not always ready to hear, causing you to miss things that people say, even though your hearing tests may show normal results.
The tensor veli palatini muscles pull open the eustachian tube during swallowing and yawning. When their tonus is disturbed, they may become unable to pull the tube open enough to equalize pressure between your middle ear and the outside air, which makes your ears feel blocked or stuffy, or makes them unable to clear when changing altitude like going in a plane or over a mountain.
The other cause of the ear symptoms is fluid pressure from a swollen TMJ capsule when a TMJ is inflamed. The back ends of the TMJs, where most of the TMJ bruising occurs, are located only 1.5 millimeters from the front of the middle ear; and inflammation from chronic bruising of the retrodiskal tissues there can produce increased fluid pressure that can easily cross the thin membrane bones separating them from the ear. The increased fluid pressure can disrupt the balance mechanism in the inner ear by increasing fluid pressure in the endolymphatic sacs. A recent study found that tinnitus was associated with impaired glymphatic circulation and increased water. (Weijie Y, Yinjuan D, Shuo L, et al. Altered Glymphatic Function in Tinnitus: Associations With Cognition and Effects of rTMS.Laryngoscope, January 2026)
The increased fluid pressure from a swollen TMJ capsule can also push closed the eustachian tubes, which pass just behind the TMJs. After the tubes have been pushed closed for long enough, they become narrow in the area just behind the TMJs.
INDICATOR SYMPTOMS - Whatever symptoms characterize your TMJ disorder generally move together in the same direction, but not at the same speed. Some respond faster than others. The more rapidly responding symptoms serve as indicator symptoms - they let us know if the treatment is on track. Pain is the best indicator symptom, even mild pain such as chronic ache or facial soreness. The ear symptoms are the worst indicator symptoms, because their response is more irregular. Tinnitus is the most irregular. It can even get worse before it gets better.
EPIDEMIOLOGY
CHILDREN - rarely suffer from serious TMJ disorder symptoms, because their extensive capacity for growth adaptation will change their facial structure to accommodate even extreme bite strain. Their faces will grow crooked rather than allowing the strain to create tissue damage.
WOMEN - are much more commonly affected than men, because their more downward and backward facial growth pattern diverges from the average male facial growth pattern at puberty, when predominantly females start showing significantly more signs and symptoms of TMJ disorders. This difference in male and female adult facial growth patterns is illustrated in CAUSES under the tab FOR DOCTORS.
THE ELDERLY - rarely experience TMJ inflammation, because damaged TMJs heal anatomically due to fibrosis of the retrodiskal tissues. This successful adaptation can take a day or a decade, but it almost always occurs by middle age. Older people can still suffer from jaw muscle pain as a subset of postural muscle pain, because the mandible is an integral component of the head posture mechanism. Also, they can have difficulty chewing due to an unstable or displaced bite. However, they are unlikely to develop an acutely painful TMJ disorder, unless they have an extremely strained bite, worn out dentures, or a systemic arthritic condition like rheumatoid arthritis that happens to attack the TMJs. Also any TMJ injuries that the elderly experience usually respond quickly to simple treatment or even just time. These joints were designed to undergo many injuries and still function adequately.
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